Побочные эффекты андрогенной депривации при раке предстательной железы и способы их коррекции: систематический обзор

Введение. Современные варианты терапии местнораспространенного и метастатического рака предстательной железы позволяют достичь высоких показателей выживаемости, в связи с чем на первый план выходят вопросы качества жизни и коррекции сопутствующих заболеваний, нередко становящиеся основной причиной летальности пациентов этой когорты. Метаболические нарушения являются одним из наиболее частых нежелательных побочных эффектов андрогендепривационной терапии. В настоящее время описаны различные варианты их коррекции, однако не предложена единая стратегия.

Цель. Актуализировать и систематизировать современные данные о патогенезе метаболических нарушений, индуцированных андрогендепривационной терапией, и провести анализ мультидисциплинарных подходов к их коррекции.

Материалы и методы. Проведены поиск, анализ и систематизация релевантных публикаций в базах данных PubMed, Google Scholar, elibrary.ru и cyberleninka.ru с использованием следующих ключевых слов: «рак предстательной железы», «андрогендепривационная терапия», «метаболические нарушения», «саркопения», «остеопороз», «инсулинорезистентность». Исключены тезисы конференций и авторефераты диссертаций, комментарии редакции. В результате из 158 публикаций отобрано 79, включенных в настоящий обзор. Для написания введения использованы 19 источников, 60 источников использованы при написании основной части, 7 источников, указанных ранее в основной части, – для написания обсуждения.

Результаты. На основании обзора нами предложены рекомендации по дообследованию больных раком предстательной железы, получающих андрогендепривационную терапию, а также представлены перспективные подходы, позволяющие снижать метаболические нарушения и повышать онкоспецифическую выживаемость. Так, агонисты рецепторов глюкагоноподобного пептида-1 и статины способны не только корригировать метаболические нарушения, но и влиять на канцерогенез. Ингибиторы RANKL также обладают двойным действием, разрывая порочный круг костной резорбции при метастазах. Доказано положительное влияние физической активности и коррекции питания на качество и продолжительность жизни данной когорты пациентов. Модификации андрогендепривационной терапии путем применения интермиттирующего режима или использования антагонистов рилизинг-гормонов также позволяет снизить риск метаболических осложнений.

Выводы. Комплексный подход к наблюдению и терапии способствует увеличению качества и продолжительности жизни пациентов с раком предстательной железы, получающих андрогендепривационную терапию, а также улучшению результатов системной противоопухолевой терапии.

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